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The vast majority of patients fail nonoperative means, necessitating surgical intervention in some capacity
2%
11/598
Most patients improve with physical therapy alone and do not require additional treatment
86%
516/598
Arthroscopic subacromial decompression provides superior outcomes at two years compared to nonoperative treatment
4%
24/598
Platelet-rich plasma injections more reliably achieve symptom resolution compared to placebo injections
3%
16/598
The majority of patients experience permanent resolution of symptoms without recurrence following physical therapy
26/598
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This 46-year-old female suffers from rotator cuff tendonitis secondary to subacromial impingement due to her type III acromion. Despite the anatomical consideration, physical therapy/rotator cuff strengthening often results in the complete resolution of symptoms without additional treatment (Answer 2). Rotator cuff tendonitis is a common cause of shoulder pain. A number of etiologies/biomechanical considerations have been proposed to cause the condition, with the most notable being subacromial impingement. While anatomical aberrancies have been identified, a large amount of literature has examined the efficacy of nonoperative treatments, including physical therapy, non-steroidal anti-inflammatories, and corticosteroid injections. In the presence of rotator cuff tendonitis and partial rotator cuff tears, physical therapy has repeatedly been shown to be as efficacious as surgical interventions, namely subacromial decompression with or without rotator cuff debridement. Kesikburun et al. performed a double-blinded randomized, controlled trial comparing the efficacy of platelet-rich plasma to saline injections in conjunction with physical therapy in 40 patients with rotator cuff tendinopathy. While the authors noted significant improvements in quality of life, disability, function, and pain in those receiving PRP injections, the improvements were similar to those receiving saline injections. The authors conclude the PRP injections likely do not provide any enhanced therapeutic relief and do not recommend routinely utilizing the injection in these select patients. Ketola et al. conducted a prospective RCT examining two-year outcomes in 140 patients with subacromial impingement undergoing either physical therapy or subacromial decompression followed by therapy. The authors noted significant improvement in both groups regarding pain or disability, but the latter treatment accrued significantly more cost. The authors conclude acromioplasty does not appear to provide an additional benefit compared to physical therapy alone in those with subacromial impingement.Figures A and B represent AP and scapular Y views of the right shoulder demonstrating a concentric glenohumeral joint with no evidence of degenerative disease and a type III Bigliani acromion.Incorrect Answers:Answer 1: The majority of patients tend to experience resolution of their symptomsAnswer 3: Arthroscopic decompression in conjunction with physical therapy does not improve outcomesAnswer 4: PRP injections have been shown to provide no additional benefit in the nonoperative management of tendonitisAnswer 5: Rotator cuff tendonitis, while typically resolving with therapy, tends to recur at a later point
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